RESUMO
Objectives: Diabetes mellitus (DM) and tuberculosis (TB) are global public health concerns and leading causes of mortality and morbidity worldwide. Coinfection is known to complicate TB control and outcomes. However, there is no national study regarding the prevalence of DM among TB patients in Oman. The objective of the current study was to assess the prevalence of DM and its associated factors among TB patients in Muscat, Oman. Methods: We conducted an analytical cross-sectional study using secondary data from the electronic system of the Ministry of Health (Al-Shifa 3+). It includes all adult TB patients in Muscat, from 2017-2020. Sociodemographic data, clinical characteristics, and comorbidities of TB patients were collected. SPSS with 95% CI and p-value ≤ 0.05 was used for statistical analysis. Results: Of 426 TB cases, the prevalence of DM was 27.0%. The associated factors of DM were age group 40-54 years (odds ratio (OR) = 9.08, 95% CI: 4.16-19.84) and ≥ 55 years (OR = 11.35, 95% CI: 5.19-24.82), male (OR = 2.35, 95% CI: 1.45-3.81), being married (OR = 13.18, 95% CI: 4.72-36.84), being employed (OR = 2.30, 95% CI: 1.19-4.47), and Bangladeshi (OR = 7.08, 95% CI: 2.50-20.12) or Indian (OR = 6.14, 95% CI: 2.40-15.70) nationality. The absence of Bacillus Calmette-Guérin scar (OR = 2.06, 95% CI: 1.19-3.56), death (OR = 7.08, 95% CI: 1.26-7.82), and cured after TB treatment (OR = 3.02, 95% CI 1.71-5.31) showed significant association. Also, smoking (OR = 2.93, 95% CI: 1.81-4.76), drinking alcohol (OR = 1.79, 95% CI: 1.10-2.91), hypertension (OR = 10.45, 95% CI: 5.29-20.64), heart disease (OR = 8.50, 95% CI: 1.69-42.77), and renal disease (OR = 4.84, 95% CI: 1.71-13.64) contributed to the study's comorbidities. Old age (adjusted OR = 2.30, 95% CI: 1.72-3.06) and hypertension (adjusted OR = 5.21, 95% CI: 2.28-11.87) were found to be predictors of DM among TB patients. Conclusions: The prevalence of DM among TB patients in Muscat is high. Integrated systematic bidirectional TB-DM screening is needed. Furthermore, special attention is required for associated factors when managing these comorbidities.
RESUMO
Any insult that affects survival of ovarian antral follicles can cause abnormal estradiol production and fertility problems. Phthalate esters (PEs) are plasticizers used in a wide range of consumer and industrial products. Exposure to these chemicals has been linked to reduced fertility in humans and animal models. Di-(2-ethylhexyl) phthalate (DEHP) and mono-(2-ethylhexyl) phthalate (MEHP) decrease serum estradiol levels and aromatase (Arom) expression, prolong estrous cycles, and cause anovulation in animal and culture models. These observations suggest PEs directly target antral follicles. We therefore tested the hypothesis that DEHP (1-100 microg/ml) and MEHP (0.1-10 microg/ml) directly inhibit antral follicular growth and estradiol production. Antral follicles from adult mice were cultured with DEHP or MEHP, and/or estradiol for 96 h. During culture, follicle size was measured every 24 h as a measurement of follicle growth. After culture, media were collected for measurement of estradiol levels and follicles were subjected to measurement of cylin-D-2 (Ccnd2), cyclin-dependent-kinase-4 (Cdk4), and Arom. We found that DEHP and MEHP inhibited growth of follicles and decreased estradiol production compared to controls at the highest doses. DEHP and MEHP also decreased mRNA expression of Ccnd2, Cdk4, and Arom at the highest dose. Addition of estradiol to the culture medium prevented the follicles from DEHP- and MEHP-induced inhibition of growth, reduction in estradiol levels, and decreased Ccnd2 and Cdk4 expression. Collectively, our results indicate that DEHP and MEHP may directly inhibit antral follicle growth via a mechanism that partially includes reduction in levels of estradiol production and decreased expression of cell cycle regulators.